SpineMap 3D User Manual sw 2.0 Rev A July 2010

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SpineMap® 3D

User Manual

SpineMap® 3D Navigation Software 2.0

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Introduction/Description of Symbols

This user manual provides general instructions on the use of the

Stryker Navigation System software for image guided computer

assisted orthopaedic surgery.

It contains information on the

planning, navigation, functions

and the general concept of operations for SpineMap 3-D Navigation.

Symbol used in this document

Symbol

W

Description

Marks a warning or caution message

Symbols used in the software

Symbol

Description

Marks an information message

Marks an error message

Marks a warning message









i

User Group

Medical Professional (surgeon/resident, radiologist, nurse/professional caregiver)

For the required safety information and contraindications, please refer to the SpineMap 3-D 2.0 Safety

Information and the Imaging Protocol supplied with the software package, as well as the instructions for use

supplied with the system components.

Refer to

documentation

For detailed instructions and the required safety information related to the Anchoring systems, Anchoring Pins,

Point and Vector Calibration Devices, refer to the instructions for use supplied with these instruments.

For information related to the use of conventional instrumentation, please refer to the user documentation

supplied with each company’s conventional instrumentation.

As with any technical guide, the surgeon should consider the particular condition of the patient and perform the necessary adjustments if required.

Safety and caution should always be utilized before proceeding.

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Set Up System and Log In

1. Set Up System and Log In

1. Plug in the main power cable

of the navigation system.

2. Press the main power button

on the front panel of the navigation system.

3. Enter the user name (navigation) and press the Enter key

or use the left mouse button

to click the OK button.

4. After Application Manager

start up, use the mouse to

select SpineMap 3-D.

Note

The system setup can be completed by the OR support staff

prior to operation.

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Refer to Imaging Protocol

2. Refer to Imaging Protocol

Stryker SpineMap 3-D navigation software requires a CT image

set as a basis for navigation. If

required, additional image sets of

different modalities can be fused

with the CT base images.

ff

For navigation efficiency and

accuracy, follow the recommendations for image acquisition as depicted in the Stryker

SpineMap 3-D Imaging

Protocol.

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Import Image Sets

3. Import Image Sets

Step 1: Select media

Image data can be read from CD,

DVD, Sony/ Maxoptix MO Disk,

USB memory stick or network.

Read image data from media

ff

Insert the media into the

appropriate drive of the navigation system.

The software detects the media

and new image sets automatically.

To start a new case using new

image sets:

ff

Select the Start New Case link

from the Home page.

The Image Sets dialog is activated by the software and the new

image series are automatically

listed.

Read image data from network

The software automatically

detects the image files available

on the network. To retrieve new

image sets from the network:

ff

Select the There are <n> new

image sets ... link from the

Home page.

The Image Sets dialog is activated by the software and the new

image series from the network are

automatically listed.

To preview images:

ff

Select the required image set

from the desired patient listed

in the media content tree.

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Import Image Sets

Step 2: Verify image set

Image set verification enables

you to adjust the contrast and the

surface level of the image set, to

confirm the image orientation

and to select the preferred viewing

direction of images.

Adjust contrast and surface level

1. Click the

icon and open

the Window Width / Level

box.

2. Click the Automatic Adjust

button or use the sliders to

adjust contrast (window level/

width) of the images and

surface level of the 3-D rendering.

Confirm image orientation

ff

Verify that the Image orientation labels are correct on each

of the planes.

WWWarning

Ensure proper image orientation.

Severe accuracy errors result from

incorrect orientation.

If the image orientation label is

incorrect:

1. Move the mouse over the

orientation label requiring

correction.

2. Select the correct orientation

from the pull-down menu.

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Import Image Sets

Step 3: Reduce image set

size (optional)

If necessary, the file size of the

image set to be imported can

be reduced. The RAM indicator

shows the used main memory of

the image set to be imported.

The following procedures help

you to reduce the image set file

size.

Set local import bounding box

The software provides the selection of an import area of the

image set.

ff

Use the mouse to set the

bounding box over the import

area.

The software imports only the

part inside of the bounding box.

Select and deselect single slices

In the Slices view, single slices can

be deselected.

1. Click the Slices tab to switch

to the Slices view.

2. Move the mouse over the

desired slice. The Import

pop-up appears. Deactivate

the checkbox to deselect slice.

Select and deselect all/every even/

every odd/every third slice

In the Slices view, single slices can

be deselected.

1. Click the Slices tab to switch

to the Slices view.

2. Click

to select all/every even/every

odd or every third slice.

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Import Image Sets

Import image set with half resolution

The half resolution feature

enables image sets to be imported

in half resolution.

WWWarning

Reduction of the resolution may

lead to inadequate image quality. Do not reduce the subvolume

or resolution in regions in which

medical indications require the

available image quality. Only

reduce the subvolume or resolution according to established

medical standards.

It is the surgeon’s responsibility to

set the subvolume and resolution.

In case of an unintended reduction of the subvolume or of the

resolution, import the original

scan again.

to convert image set

ff

Click

to half resolution.

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Import Image Sets

Step 4: Import images

To import the selected image set:

1. Select the Import button.

2. Accept the confirmation message:

ff

Proceed to Planning.

ff

Import more image sets.

If required, import additional

image sets for this particular

patient.

ff

Select the desired additional

image set from the media

content tree.

ff

Repeat steps 1 and 2.

If all required image sets are

imported:

ff

Select the Next button to

proceed.

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Confirm Patient Data

4. Confirm Patient Data

Step 1: Confirm patient

data

ff

Confirm patient data listed at

top of the screen.

If patient data needs to be

changed or added:

1. Select the Update Patient

Data link. The Update Patient

Related Data window is

opened.

2. Change or add patient data.

Note

Date of birth is mandatory in

order to ensure unique patient

identification. If required, add the

correct date of birth.

Step 2: Select surgery

direction

1. Select the surgery direction required for the current

patient.

Step 3: Select planning

features

1. Select the planning features

required for the current

patient.

2. Select the Next button to

proceed.

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Planning Features

5. Planning Features

Image Set Correlations

Local Correlation

Overview

SpineMap 3-D software offers a

vast selection of dedicated planning features. The planning

features add functionality to

navigation.

The features available in the Planning dialog depend on the selection made in the Patient dialog.

Segmentation

Planes

Image Set Correlations

Fuse multi-modal images such as

CT and MRI.

Local Correlations

Select a local correlation region

with an adjustable box.

Segmentation

Trajectories

3-D Model

Accentuate anatomical structures of interest such as aberrant

anatomy, soft tissue, tumors, bone

surfaces and vessels.

Planes

Plan and assess resection planes

and the required margins.

Trajectories

Plan and assess surgical trajectories.

3-D Model

Display imported 3-D models

inserted into section and 3-D

images.

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Planning Features

Anatomical System

Anatomical System

Create multiple anatomical systems per series.

Screws

Plan and assess screws that may

be required for reconstruction.

Measurements

Measure distances and angles.

Annotation Points

Screws

Measurements

Annotation Points

Compositions

Mark points of interest and add

personal notes.

Compositions

Create image sets displaying

image modalities, segments and

planned items in a way best suited

for the intended intervention.

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Planning Features

Image set correlations

If two or more image series

for the same patient have been

imported, the image correlation

process can be started.

WWWarning

Different patient positions during

imaging and movement of soft

tissue may result in compromised

image correlation accuracy. To

achieve adequate correlation for

the bony structures of interest,

manual matching correction may

be required.

Step 1: Select series

ff

Select or deselect the pairs of

series to correlate.

Note

Only pairs of image sets can be

correlated.

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Planning Features

Step 2: Start automatic

matching

The complete automatic matching

process may take a few minutes.

For better visualization of the

ongoing process, the two image

series are displayed in different

colors.

ff

Click the Automatic Matching link to start the automatic

matching process.

Note

The matching process can be

terminated manually if no further

alignment takes place.

Step 3: Confirm automatic

matching

ff

Visually verify the suggested

result of the automatic matching process by using well

known landmarks.

If the correlation is acceptable:

ff

Confirm the result by clicking

the checkbox.

If automatic image correlation is

not acceptable:

ff

Perform the Manual matching or activate the Landmark

matching dialog and repeat

the image correlation.

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Planning Features

Local correlations

It is also possible to define correlation regions that are correlated

to the selected navigation base

series.

WWWarning

Different patient positions during

imaging and movement of soft

tissue may result in compromised

image correlation accuracy. To

achieve adequate correlation for

the bony structures of interest,

manual matching correction may

be required by a method such as

landmark matching.

Guidelines for local correlation

regions

For adequate results, follow these

guidelines:

•• Do not include any adjacent

anatomy into the region that

is connected by a joint to the

target anatomy. The position

of the adjacent anatomy may

be different in each image set.

•• Only include bony anatomy in

the target region because the

position of soft tissue may be

different in each image set.

•• The bounding box for defining the local correlation

should be scaled down in all

space directions so that only

a vertebra or the sacrum is

included.

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Planning Features

For adequate correlation results,

a local correlation for a vertebra

should be defined similar to the

following pictures.

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Planning Features

Step 1: Select series

1. Select New Local Correlation.

2. Position the cursor on the

vertebra of interest.

3. Select the base image series for

correlation.

4. Define the correlation region

with the adjustable box.

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Planning Features

5. Select the second image series

for correlation.

6. Adjust the second image series

for correlation.

Note

Parts outside of the correlation region are dimly displayed.

When a local correlation region

is selected, the system shows the

image set on which the region’s

adjustable box has been defined.

Step 2: Start automatic

matching

ff

Click the Automatic Matching link to start the automatic

matching process.

The complete automatic matching

process may take a few minutes.

For better visualization of the

ongoing process, the two image

series are displayed in different

colors.

To check the result during the

matching process:

ff

Click the icon and use the

image box functionality.

Note

The matching process can be

terminated manually if no further

alignment is needed.

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Planning Features

Step 3: Confirm automatic

matching

ff

Visually verify the accuracy

of the automatic matching

process by using well known

landmarks.

If the correlation is accurate:

ff

Confirm the result by clicking

the Confirmed checkbox.

If automatic image correlation is

not satisfactory:

ff

Perform the Manual matching or activate the Landmark

matching dialog and repeat

the image correlation.

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Planning Features

Segmentation

There are two segmentation

workflows.

WWWarning

During navigation, soft tissue

movement may result in erroneous navigational information of

the (segmented) soft tissue anatomy. For each segment, a safety

margin can be defined. During

navigation, the software warns

surgeons visually and audibly

as soon as the navigated tool tip

enters this safety margin.

Step 1: Define segment

type

1. Double-click the image set

that best shows the volume of

interest (for example CT for

bone segmentation and MR

for tumor segmentation).

2. Select New Segment below

the selected image set. Upon

selection, the Segmentation

tool panel is displayed.

ff

Select one of the pre-defined

segment types from the pulldown menu: Bone, Tumor,

Vasculature or User Defined.

The Segmentation tool panel

is expanded.

ff

Select the Automatic Segmentation button.

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Planning Features

Step 2: Start automatic

segmentation

1) Bone Segmentation

1. If required, limit the segmentation space by moving the

boundaries of the rectangular

segmentation box displayed in

the 2-D and 3-D views.

2. Set the crosshair cursor in an

area displaying the bone to be

segmented.

3. Select the Calculate button.

The bone is segmented.

4. Assess the visibility and borders of the segmented bone in

the 2-D and 3-D views.

If the bone is segmented insufficiently:

ff

Lower the Hounsfield threshold to add more cartilage

or thin bone to the bony

structures by moving the

Hounsfield unit slider.

If the bone is satisfactorily segmented:

ff

Click the Finish button to

finalize and save the bone segment.

Note

Automatic bone segmentation

works only with CT image sets.

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Planning Features

2) Tumor/ Vasculature/

User Defined Segmentation

1. If required, limit the segmentation space by moving the

boundaries of the rectangular

segmentation box displayed in

the 2-D and 3-D views.

2. Set the crosshair cursor into

an area showing tissue to segment.

3. Select the Start button. The

structure of interest is segmented.

4. Assess the visibility and borders of the segmented structure in the 2-D and 3-D views.

If the structure of interest is segmented with imperfect borders:

ff

Move the Tolerance slider

until the structure of interest

has reached its optimal visibility.

If the structure of interest is segmented partially and not sufficiently connected to be segmented

in one instance:

ff

Add a new portion to the

structure already segmented

by clicking the More button

and by repeating the Segmentation dialog.

ff

Once the structure is satisfactorily segmented, click the

Finish button to finalize and

save the segment.

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Planning Features

Planes creation

There are two options for resection plane planning: digitizing an

initial axis perpendicular to the

desired resection plane or digitizing three points to define the

desired plane.

Planes are commonly planned for

pelvectomies, sacrectomies and

long bone resections.

For long bones the axis based

resection plane enables easy alignment of perpendicular cutting

planes to the bone shaft.

Step 1: Create new plane

1. Select the image set in which a

plane is to be defined by clicking the image set item in the

patient record tree.

2. Double-click the Planes item

and select New Plane. Upon

selection, the Planes tool

panel is displayed.

Step 2: Select method for

plane creation

ff

Select the desired plane creation method from the pulldown menu: Axis or 3 Points.

The tool panel is expanded for

the selected plane functionality.

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Planning Features

Step 3: Create new planes

1) Axis Method

1. Set the crosshair cursor on

the first point of a virtual axis

that lies perpendicular to the

desired plane (for example

the proximal center point of a

bone shaft).

2. Select the Set Axis Point 1

button to record the position.

3. Set the crosshair cursor on

the second point of the virtual axis perpendicular to the

desired plane (for example the

distal center point of a bone

shaft).

4. Select the Set Axis Point 2

button to record the position.

A plane perpendicular to the

digitized axis is displayed.

5. Select the Plane Oriented tab.

6. Make sure that the plane and

bony intersection mark the

resection line appropriately.

If required:

ff

Adjust the shape (Ellipse/

Rectangle), the size (Size X,

Size Y), the opacity, and the

rotation of the plane using the

radio buttons and the sliders.

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